From the Guidelines
The long-term risk of stroke after experiencing a COVID-associated stroke is significantly elevated, with patients facing approximately a 2-5% annual risk of recurrent stroke in subsequent years, as supported by recent guidelines 1. This risk appears to be highest in the first year following the initial stroke and gradually decreases over time, though it remains elevated for several years.
Key Factors Influencing Long-Term Risk
- The effects of COVID-19 on blood coagulation, endothelial damage, and inflammatory responses that can persist beyond the acute infection, creating a prothrombotic state.
- Underlying conditions that may have contributed to the stroke, such as atrial fibrillation or diabetes.
Management Strategies
- Aggressive secondary stroke prevention with antiplatelet therapy, such as aspirin 81-325mg daily or clopidogrel 75mg daily, as suggested by recent expert panel reports 1.
- Statins for cholesterol management.
- Blood pressure control, targeting <130/80 mmHg.
- Lifestyle modifications, including smoking cessation, regular physical activity, and a Mediterranean-style diet.
Importance of Adherence and Follow-Up
Regular follow-up with a neurologist and adherence to prescribed medications are crucial for minimizing this long-term risk, as emphasized in recent guidelines 1. Therefore, it is essential to manage patients who have experienced a COVID-associated stroke with a comprehensive approach that includes antiplatelet therapy, statins, blood pressure control, lifestyle modifications, and regular follow-up to minimize the long-term risk of recurrent stroke.
From the Research
Long-term Risk of Stroke after Covid-Associated Stroke
The long-term risk of stroke after a Covid-associated stroke is not directly addressed in the provided studies. However, the studies do provide information on the risk of stroke in patients with Covid-19 and the potential factors that contribute to this risk.
Risk of Stroke in Covid-19 Patients
- The risk of stroke in patients with Covid-19 is estimated to be around 1-6% 2.
- The risk of stroke is more than sevenfold greater in patients with Covid-19 than in those with influenza 2.
- The risk of acute stroke is increased in patients with severe Covid-19 compared to those with non-severe Covid-19 (RR = 4.18,95% CI: 1.7-10.25; P = 0.002) 3.
Factors Contributing to Stroke Risk
- Immune-mediated thrombosis, the renin angiotensin system, and the effect of SARS-CoV-2 on cardiac and brain tissue may contribute to the pathogenesis of ischemic stroke in patients with Covid-19 4.
- Coagulopathy, inflammation, platelet activation, and alterations to the vascular endothelium are also potential factors that contribute to the risk of stroke in Covid-19 patients 2.
Management and Treatment
- The use of statins, aspirin, and renin-angiotensin-aldosterone inhibitors may be associated with reduced mortality in patients with Covid-19 5, 6.
- Atorvastatin was associated with reduced mortality in patients with Covid-19 (OR: 0.18,95% CI: 0.06-0.49, P = 0.001) 5.
- ACEIs and ARBs may be associated with a decreased risk of 30-day all-cause mortality in Covid-19 patients, particularly in those with hypertension 6.